title: Satisfaction after the Malone antegrade continence enema procedure in patients with spina bifida.
abstract: METHODS
  Retrospective chart review.
  
  
  OBJECTIVE
  To evaluate the clinical outcomes and factors influencing patient satisfaction with Malone antegrade continence enema (MACE) in patients with spina bifida.
  
  
  METHODS
  Japan.
  
  
  METHODS
  We performed retrospective analysis of 21 patients with spina bifida who underwent surgical creation of an MACE stoma. Clinical outcomes were evaluated by medical records, operative notes and mailed questionnaires. Patient satisfaction scores (SSs) were measured on a modified visual analog scale (VAS) from 1 to 10, and the factors influencing the SS were analyzed.
  
  
  RESULTS
  A 100% return rate for the mailed questionnaires was achieved. All patients underwent in situ appendicocecostomy with cecal plication. There was only one complication that required surgical revision. Regarding fecal continence, the overall success rate was 90%. Although 4 patients (19%) had severe irrigation pain and 4 patients (19%) found the washout time intolerably long, 18 (85%) of them were satisfied with the MACE procedure. Age at operation, experience of retrograde colonic enema (RCE), experience of stomal leakage, increased comfort at school or workplace and increased comfort at sleepovers significantly influenced SSs.
  
  
  CONCLUSIONS
  MACE is a valuable option in achieving fecal continence in patients with spina bifida, with most patients being satisfied with the procedure. In our analysis, younger age at operation, previous experience of RCE, no stomal leakage and improvement of quality of life (enhanced comfort at school, workplace and sleepovers) significantly influenced the high satisfaction after MACE.
authors.affiliation: Department of Urology, Kanagawa Children's Medical Center, Yokohama, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Imai
authors.affiliation: Department of Urology, Kanagawa Children's Medical Center, Yokohama, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Shiroyanagi
authors.affiliation: Department of Urology, Kanagawa Children's Medical Center, Yokohama, Japan.
authors.forename: W J
authors.initials: WJ
authors.lastname: Kim
authors.affiliation: Department of Nursing, Kanagawa Children's Medical Center, Yokohama, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Ichiroku
authors.affiliation: Department of Urology, Kanagawa Children's Medical Center, Yokohama, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Yamazaki
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D003248:Constipation / Q000209:etiology / Q000601:surgery*; D005242:Fecal Incontinence / Q000209:etiology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D017060:Patient Satisfaction; D012189:Retrospective Studies; D016135:Spinal Dysraphism / Q000150:complications*; D054047:Surgical Stomas; D055815:Young Adult